It Seems the Cigarette Industry Helped Create the Type-A Personality

When Chelsea Clinton took the stage at the Democratic National Convention in July, she told a story from her childhood about the way her mother would prep for long business trips. “Whenever my mom was away for work … she left notes for me to open every day she was gone,” she said. “All stacked neatly together in a special drawer with a date on the front of each one, so I would know which note to open which day.” Beyond “humanizing” Hillary Clinton, by presenting her as an engaged, involved mom, this little anecdote did something else: It confirmed for the viewers that, yes, Clinton is maybe just a little bit Type A.

It’s a good example of the way this personality type tends to be characterized: These are the the excessively organized, the hard-chargers, the go-getters, the probable bullet journalers. It’s Stef Oud, a senior partner at Deloitte who rises at 4:30 a.m. each day to train for an Ironman; it’s Leslie Knope and her armful of binders; it’s the tiresome friend who sends you calendar invites for a simple happy hour. To non-Type A’s, the personality is sometimes puzzling, sometimes exasperating, but most of us can at least grudgingly admit that their on-top-of-things nature is admirable. “A lot of people want to be Type A,” as Mike Pesca put it on a recent episode of The Gist podcast. Calling yourself “a little Type A” is like answering the classic job interview question about your biggest weakness with “I’m a perfectionist,” a wink-y way to admit a flaw that is not really a flaw at all.

Detail-oriented as they are, the Type A’s among us may be interested to know three curious facts concerning the origin story of their personality type, which began showing up in academic-journal articles in the 1950s:

Fact one: When the Type A personality was introduced into the medical lexicon by a pair of cardiologists, it was considered a negative thing — a behavior pattern to avoid, not to admire, as it would lead to stress-induced heart attacks (or so they claimed).

Fact two: From the 1960s through the 1990s, much of the research on Type A behavior was partially funded by two tobacco companies, Philip Morris and R.J. Reynolds, according to an extensively researched paper published in Public Health Ethics by Mark P. Petticrew, a professor of public health at the London School of Hygiene and Tropical Medicine, and his colleagues Kelley Lee and Martin McKee. (This caught my eye when Alex Mayyasi wrote about this for Priceonomics earlier this year.)

And fact three: Given the previous two truths, this means that the Type A personality has no real definition, as psychology writer Maria Konnikova has pointed out. It’s a self-concept that was, at least in part, created by the cigarette industry.

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Beginning in the late 1950s, two cardiologists — Meyer Friedman and Ray H. Rosenman — began publishing their work on “type A behavior pattern” — that is, people who are excessively ambitious, competitive, and aggressive. Men who exhibited such behavior, Friedman and Rosenman argued, were seven times more likely to have heart disease as their comparatively mellow — that is, Type B — counterparts. (Their interest may have been personal. Rosenman described himself as “Type A-minus,” and Friedman was nicknamed “Cannonball Mike” because of his “his explosive way of coming into a room.”) The pair of researchers, along with others at the time, would publish books and hold training seminars encouraging people to resist their A tendencies and try to be more B. Being Type A, in other words, was not a desirable thing.

By the late 1950s, Petticrew and his colleagues report, the work had caught the eyes of tobacco-industry executives reeling from a decade’s worth of damning scientific research connecting cigarettes and health problems, including the 1952 blockbuster story in Reader’s Digest, “Cancer by the Carton,” and the 1954 statement from the American Cancer Society acknowledging the link between smoking and cancer risk. Also around this time, research began to surface associating smoking with heart disease. Some execs, as they did in the fictional world of Mad Men, turned to advertising agencies to help rehabilitate cigarettes’ reputation; others, the researchers note, turned to research scientists. What if, as Friedman himself argued, it wasn’t so clear-cut as cigarettes causing heart disease? What if, instead, people who are easily stressed tend to have more heart problems, and people who are more easily stressed are also more likely to smoke? As Friedman said in the journal Medical Times in 1962:

It seems probable that heavy cigarette smokers have more clinical coronary artery disease than non-smokers. Does this mean that excess nicotine is responsible? Or does it mean that persons exhibiting the behavior pattern I described above tend to smoke more? In other words, are we mistaking a concomitant for a cause? I am positive we are.

On the one hand: He has a point. Very few researchers up until that time had seriously explored how behavior interacts with longevity, or what would later become the field of health psychology. At the same time, you can imagine why this line of scientific inquiry might be of particular interest to cigarette makers. Later that year, the public-relations firm behind an organization called the Council for Tobacco Research included Friedman on a list of scientists who were “serious workers in their respective fields who have not appeared as protagonists in the debates on tobacco and health.” In the years to come, that council would produce a series of leaflets and pamphlets and films loosely inspired by work from Friedman, Rosenman, and others on the Type A personality. The underlying message — with statements like, “The type most susceptible [to a heart attack] … is the hard-driving man with excessive ambition and competitiveness” — was that psychological stress could just as easily be a cause of heart disease as smoking.

Consider, for example, the Coronary/Cancer Prevention Project, a ten-year trial designed to test whether Type A’s could be counseled out of their Type A–ness, and if that, in turn, would lead to fewer diagnoses of heart disease or cancer. It was launched as a follow-up to a five-year trial with a similar focus. That initial study received no funding from the tobacco industry, but the Coronary/Cancer Prevention Project “was largely funded by Philip Morris, which provided $4.76 million in 1988 to cover the first 5 years of the trial, an additional $2.39 million in 1991, and $3.6 million in 1995.” Jetson Lincoln, then-president of Philip Morris, was quite keen on this line of research, noting in a 1991 memo the “really large potential for shifting blame away from smoking.” In total, Philip Morris would fund the Meyer Friedman Institute with almost $11 million by 1997, according to documents unearthed by Petticrew and his colleagues.

A few other notable examples:

• A second tobacco company, R.J. Reynolds — the maker of Camel cigarettes — funded comparable research, including a study launched at Yale University investigating potential psychological causes of heart attacks. (The money came from the Meyer Friedman Institute, “to circumvent Yale’s ban on accepting tobacco-industry funding,” Petticrew and his colleagues note.)

• In preparation for a 1984 Tampa Bay Workshop on Stress, Heart Disease and Cancer, “the R.J. Reynolds Research Committee liaised closely with the organizers regarding the content of the workshop report,” recommending a panel of experts that “met in the offices of the tobacco industry lawyers to draft the workshop’s conclusions and recommendation.”

• From 1985 to 1989, Philip Morris provided $5 million in funding for behavioral research at Duke University, in hopes that the studies conducted there would be aimed at “promoting the role of psychosocial stresses in mortality,” write Petticrew et al.

In the end, though, it all fizzled, anyway: Overall, the majority of these research projects failed to find a clear link between the Type A personality and poorer heart health. According to a 2002 systematic review of the literature, only one of the 11 prognostic studies found that Type A behavior could predict heart disease. Of the 13 etiologic studies — that is, those designed to identify a potential causal role of Type A behavior in heart disease — just four were positive; of those four, three “had a direct or indirect link to the tobacco industry.”

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Part of the problem here, as psychology writer Maria Konnikova recently observed, is that the concept of the Type A personality is not well-defined. Is it Leslie Knope’s endearing lack of chill? Or is it Lewis Black’s literally hotheaded Anger character in Inside Out? In a recent episode of the Slate podcast The Gist, Konnikova explained that when it comes to Type A and heart disease, “it turns out there’s actually very little link, partly because no one can agree what the hell Type A personality is,” she said. “And depending on how you measure it, some people are high in it and not high in it — and then you give them a different construct and it flips.” The Type A personality, then, as Konnikova said on that episode, is mostly bullshit.

And yet: Flawed as much of the Type A research was, it brought along some good — for one, it effectively launched the field of health psychology, as Susan A. Matthews, a University of Pittsburgh psychologist, has noted. “Type A behavior research was a starting point for psychological science’s understanding of the development of [cardiovascular diseases],” she wrote in a 2013 paper in Perspectives on Psychological Science. Eventually, Matthews writes, the research narrowed in on two components within the original conception of Type A — anger and hostility — which have indeed been shown to be linked to a higher risk of heart disease. The question those original researchers posed was a good one: Most health problems do have multiple causes, one of which could indeed be behaviors associated with certain personality traits.

Speaking of which, if you have long identified yourself as Type A, you might like to know what the field of health psychology has turned up about your personality by another name. The way people colloquially describe Type A tendencies sounds a lot like conscientiousness; according to a popular scientific model of personality called the Big Five, highly conscientious individuals are organized, thorough, and deadline-driven. It’s not so surprising, then, that research in health psychology has linked conscientiousness to many positive health outcomes: People who are conscientious, for example, tend to have healthier diets; they also tend to outlive their slovenly counterparts. Now, go forth and conquer your to-do list, armed with new knowledge of your self-concept’s origin story.

The Tobacco Industry Helped Create the Type A Personality